Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China.
Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China.
Eur J Radiol. 2022 Dec;157:110521. doi: 10.1016/j.ejrad.2022.110521. Epub 2022 Sep 11.
To investigate the applicability of MRI-based preoperative risk markers in assisting clinicians to define an appropriate surgical margin width for patients with solitary hepatocellular carcinoma.
Patients who underwent preoperative MRI with hepatectomy were randomly divided into development (65%) and internal validation (35%) datasets between January 2015 and January 2019. Multivariate logistic analysis was used to evaluate MRI-based markers of early recurrence (≤2 years) in the development dataset. Independent factors in the development dataset were investigated using a multivariable Cox analysis. The multivariable logistic and Cox models were verified using the risk score system in the validation dataset. Recurrence-free survival (RFS) was calculated according to MRI-based preoperative markers together with a narrow or wide margin in all datasets.
A narrow resection margin was identified as an independent risk factor for early postoperative recurrence (P < 0.001) according to multivariable Cox analysis. RFS was significantly shorter in patients with narrow resection margins than that of those with wide resection margins (P < 0.005). Patients with the three MRI-based preoperative markers (tumour size > 5 cm, substantial necrosis, and non-smooth margins) combined with a narrow resection margin had a shorter RFS than that of those with a wide margin (P < 0.005). Patients without these markers also benefitted from a wide margin (P < 0.05).
MRI-based preoperative risk markers in combination with narrow resection margins were associated with a higher recurrence rate compared with wide resection margins, and hence, such patients may benefit from a wide-margin hepatectomy.
研究基于 MRI 的术前风险标志物在协助临床医生为单发肝细胞癌患者定义适当的手术切缘宽度方面的适用性。
2015 年 1 月至 2019 年 1 月期间，将接受术前 MRI 检查并接受肝切除术的患者随机分为开发（65%）和内部验证（35%）数据集。使用多变量逻辑分析评估开发数据集中基于 MRI 的早期复发（≤2 年）标志物。使用多变量 Cox 分析研究开发数据集中的独立因素。使用验证数据集中的风险评分系统验证多变量逻辑和 Cox 模型。根据所有数据集中基于 MRI 的术前标志物和窄或宽切缘计算无复发生存率（RFS）。
多变量 Cox 分析显示，窄切缘是术后早期复发的独立危险因素（P<0.001）。与宽切缘相比，窄切缘患者的 RFS 明显更短（P<0.005）。与宽切缘相比，具有三个基于 MRI 的术前标志物（肿瘤大小>5cm、实质坏死和不光滑边缘）并伴有窄切缘的患者 RFS 更短（P<0.005）。没有这些标志物的患者也从宽切缘中获益（P<0.05）。
与宽切缘相比，基于 MRI 的术前风险标志物与窄切缘联合使用与更高的复发率相关，因此这些患者可能受益于宽切缘肝切除术。
